To the Editor.—Dysacusis is a hearing disturbance that refers to malfunction of the sense organ or to an abnormal brain function such as auditory agnosia, phonemic regression, and psychogenic "deafness."1(p85) Paracusis refers to the ability to hear better in noisy places,1(p89) and diplacusis ("hearing double") is a form of dysacusis in which a given pure tone has different pitches in the two ears.1(p96)Recently I had the opportunity to examine a patient with the curious clinical sign called echoacousia, occurring in association with the controversial Gerstmann syndrome without aphasia (acalculia, finger agnosia, left-to-right disorientation).2-4The patient was a 70-year-old right-handed woman with a history of extracranial vascular disease and compensated hypothyroidism who required admission to the hospital because of uncontrolled hypertension of sudden onset associated with a clinical presentation of right-side dysesthesias ("water running on my right side"). The neurological examination disclosed marked discalculia, finger